Community Health Research Papers - Academia.edu (original) (raw)

"Infrastructural ephemera" as a set of spontaneous affective relations critical to the success of large-scale projects of urban governance in the urban South are examined. The deep contradictions underscoring the labours of women employed as community health workers in Lyari Town, Karachi, at a time of intense gang violence, are explored. Drawing on two years of field research as a polio vaccinator in Lyari, the reach (and limits) of adaptability, skills, and labour (physical, mental, and emotional) involved in the maintenance and repair of a fragile public health infrastructure are explored. Maintaining "community health" also involves dealing mortal and aspirational death to those that provide infrastructural labour to the project of giving life. S hazia did not show up for work, and her sisters-in-law were loath to say why. A moroseness attended the group of young women assembled for the vaccination campaign that morning. Shazia, their de facto leader, was missing. Also gone was Akram, the local gang-boss, whose jokes and fl irtations were as essential to morale as his mediations were to vaccination work. News was that he had been summoned by the Army Rangers and had not been heard from since. Tacitly, all knew that the two absences were connected. Shazia and her kin were community health workers (CHWs). Together they were the backbone of the Global Polio Eradica-tion Initiative (GPEI; the campaign, henceforth) in Pakistan. Unlike her kin, Shazia had always been the picture of quiet ef-fi ciency, skillfully motivating and organising her teams. The government supervisor was completely dependent on her for managing the campaign. Shazia's absence appeared to her a personal betrayal, and she was distraught. The true locus of her dread was the World Health Organization (WHO) appointed monitor, who conducted spot-checks on their performance in the neighbourhood. Without Shazia, a misstep was inevitable , and she would hear about it from the town health offi cer. She was driven to tears anticipating the indignities to come, which clouded everyone's mood further. Buckling under these stresses, the polio drive that month was a disaster. Akram's jocular energy would have helped on such days. As a gangster of Lyari, Akram wore many hats. One of them was that of a CHW. Akram's contributions to the campaign far exceeded the purported utility of a CHW or imagined functions of a gangster. Success for the campaign in Lyari was entirely dependent on the "working relations," solidarities and affections that emerged between the CHWs and the gangs. This was ex-emplifi ed by affi nities Akram and Shazia developed for each other, and between the young sodalities they each led. This paper chronicles the import of those affi nities. The GPEI, like any large-scale project, thrives on rhythms and processes, articulating a mass of bubbling desires. Desires, for instance, that drive the WHO's imperatives from Geneva, jive with the Pakistani elite's fantasies about the city; all dovetailing with other, humbler desires for a good life. The GPEI rendered concrete these entangled desires by offering the po-liovirus as a displaced object around which to organise. The campaign thus spatialised and rationalised these libidinal investments. Thus, infrastructural to the realisation of massive transnational fantasies were tiny hopes and affi nities held by the young CHWs.